Analysis of factors potentially predicting prognosis of colorectal cancer

BACKGROUND Accurate assessment of the prognosis after colorectal cancer surgery is of great significance in patients with colorectal cancer.However,there is no systematic analysis of factors affecting the prognosis of colorectal cancer currently.AIM To systematically analyze the influence of clinical data and serological and histological indicators on the prognosis of patients with colorectal cancer,and to explore the indicators that can accurately assess the prognosis of patients with colorectal cancer.METHODS A total of 374 patients with colorectal cancer were enrolled.The clinical data,tumor-node-metastasis(TNM)stage,and Dukes stage were recorded.All patients received examinations including carcinoembryonic antigen(CEA),carbohydrate antigen 199,C-reactive protein,albumin,D-dimer,and fibrinogen as well as routine blood tests one week before surgery.The tumor location,size,depth of invasion,lymph node metastasis,and distant metastasis were recorded during surgery.The pathological tissue typing and expression of proliferating cell nuclear antigen(PCNA)and p53 were observed.All patients were followed for 3 years,and patients with endpoint events were defined as a poor prognosis group,and the remaining patients were defined as a good prognosis group.The differences in clinical data,serology,and histology were analyzed between the two groups.Multivariate COX regression was used to analyze the independent influencing factors for the prognosis of colorectal cancer.The receiver operating characteristic curve was used to evaluate the predictive value of each of the independent influencing factors and their combination for the prognosis of colorectal cancer.RESULTS The follow-up outcomes showed that 81 patients were in the good prognosis group and 274 patients in the poor prognosis group.The TNM stage,PCNA,Glasgow prognostic score(GPS),neutrophil-lymphocyte ratio(NLR),C-reactive protein/albumin ratio(CAR),D-dimer,and CEA were independent influencing factors for the prognosis of colorectal cancer(P=0.000).NLR had the highest predictive power for colorectal cancer prognosis[area under the receiver operating characteristic curve(AUC)=0.925],followed by D-dimer(AUC=0.879)and GPS(AUC=0.872).The accuracy of the combination of all indicators in predicting the prognosis of colorectal cancer was the highest(AUC=0.973),which was significantly higher than that of any of the indicators alone(P<0.05).The sensitivity and specificity of the combination were 92.59%and 90.51%,respectively.CONCLUSION The independent influence factors for the prognosis of colorectal cancer include TNM stage,PCNA,GPS,NLR,CAR,D-dimer,and CEA.The combined assessment of the independent factors is the most accurate predictor of the prognosis after colorectal cancer surgery.

Comparison of Patient Satisfaction between Brachial Plexus Block (Axillary Approach) and General Anesthesia for Surgical Treatment of Distal Radius Fractures: A Historical Cohort Study

Background: Distal radius fracture surgery is performed under general (GA) or regional anesthesia with brachial plexus block (NB). Whether anesthesia type affects patient outcomes is unclear. This study retrospectively compared patient satisfaction between GA and NB after surgery. Methods: This was a historical cohort study of 80 (34 GA and 46 NB) patients who underwent volar plate fixation of distal radius fractures. Propensity score analysis was used to generate a set of matched cases (NB) and controls (GA), yielding 14 matched patient-pairs. The simplified patient satisfaction scale was compared for primary outcomes. Secondary outcomes were anesthesia and surgery duration, hospital stay length, adverse events, postoperative analgesic requirement, and wrist range of motion (ROM) 2 weeks and 3 months postoperatively. Results: After propensity score matching, patients in almost all cases in both groups were “Satisfied” (effect size: 0.1, p = 0.572), indicating little significant difference. Significant differences in adverse events and postoperative analgesic use observed before matching disappeared after matching. Anesthesia duration and hospital stay length were significantly shorter in the NB group (effect size: -1.27 and -0.77, p = 0.00074 and p = 0.0388, respectively), as was surgery duration (effect size: -0.84, p = 0.0122) after matching. Similar to before matching, wrist ROM significantly improved in the NB group (effect size: 1.11, p = 0.0279) in the early postoperative period, but the difference disappeared at 3 months postoperatively. Conclusions: Patient satisfaction between distal radius fracture surgery under GA and NB was similar. Nerve block could help shorten hospital stay length and surgery duration and improve postoperative functional recovery.

Factors Predictive of Right Internal Jugular Vein Cross-Sectional Area Change in Response to Trendelenburg Positioning

Background/Purpose: The right internal jugular vein (RIJV) is the most commonly accessed central venous site in the cardiac operating room. The Trendelenburg position is frequently used to increase the cross-sectional area (CSA) of the RIJV to facilitate its cannulation. However, the extent of change of RIJV CSA in response to Trendelenburg positioning in anesthetized patients and its predictive factors remain unknown. Methods: Thirty-seven patients presented for the cardiac surgery, and 20 ASA I and II surgical patients without a history of cardiac disease (control) were studied. After induction of anesthesia, RIJV CSA was measured both at supine level position and in 10-degree Trendelenburg using vascular ultrasonography. Central venous pressure was measured in cardiac surgery patients only, since the patients in control group did not require invasive lines placement. Results and Conclusions: Body-surface area, central venous pressure, type of surgery and ejection fraction did not show any correlation with the degree of RIJV CSA change. RIJV dilation in response to Trendelenburg was significantly less pronounced, and more variable, in female patients.

Tachycardia Following Ganglion Impar Block

Objective: To understand an unusual complication of a low risk procedure. Design: This article chronicles the side effect of a Ganglion Impar Block. Setting: Loyola University Medical Center Outpatient Chronic Pain Clinic. Patients: One. Results: Our patient had tachycardia after a Ganglion Impar Block. Conclusions: An unusual complication of a ganglion impar block can be increased heart rate.

3D bioprinting of collagen-based materials for oral medicine

Oral diseases have emerged as one of the leading public health challenges globally.Although the existing clinical modalities for restoration of dental tissue loss and craniomaxillofacial injuries can achieve satisfactory therapeutic results,they cannot fully restore the original complex anatomical structure and physiological function of the tissue.3D printing of biological tissues has gained growing interest in the field of oral medicine with the ability to control the bioink component and printing structure for spatially heterogeneous repairing constructs,holding enormous promise for the precise treatment of oral disease.Particularly,collagen-based materials have been recognized as promising biogenic bioinks for the regeneration of several tissues with high cell-activating and biocompatible properties.In this review,we summarize 3D printing methods for collagen-based biomaterials and their mechanisms.Additionally,we highlight the animal sources of collagen and their characteristics,as well as the methods of collagen extraction.Furthermore,this review provides an overview of the 3D bioprinting technology for the regeneration of the pulpal nerve and blood vessels,cartilage,and periodontal tissue.We envision that this technique opens up immense opportunities over the conventional ones,with high replicability and customized function,which can ultimately promote effective oral tissue regeneration.

Toward Artificial Peptide Nanocapsules

HIGHLIGHTS The formation of peptide nanocapsules is facilitated by a gradient interface,where the differential solvent concentration drives the peptides to preferentially localize and assemble.The peptide nanocapsules,characterized by their hollow structures,demonstrated potential as carriers for targeted drug delivery.1 Introduction Peptide nanocapsules are a type of nanoscale delivery system that encapsulates active substances within a shell composed of peptides,leveraging the unique properties of peptides such as biocompatibility and biodegradability[1].Historically,the development of peptide nanocapsules was inspired primordially by the natural biological processes.

Fish consumption and incidence of heart failure： a meta-analysis of prospective cohort studies

Background The association between fish consumption and heart failure （HF） incidence is inconsistent. Methods We performed a systematic search of Pubmed and Embase （from 1953 to June 2012） using key words related to fish and HF. Studies with at least three categories of fish consumption reporting both relative risk （RR） and corresponding 95% confidence interval （CI） for HF incidence were included. The pooled RR and 95%C/were calculated using a fixed or random-effects model. The generalized least squares regression model was used to quantify the dose-response relationship between fish consumption and HF incidence. Results Five prospective cohort studies including 4750 HF events of 170 231 participants with an average of 9.7-year follow-up were selected and identified. Compared with those who never ate fish, individuals with higher fish consumption had a lower HF incidence. The pooled RRs for HF incidence was 0.99 （95%CI, 0.91 to 1.08） for fish consumption 1 to 3 times per month, 0.91 （95%CI, 0.84 to 0,99） for once a week, 0.87 （95%CI, 0.81 to 0.95） for 2 to 4 times per week, and 0.86 （95% CI, 0.84 to 0.99） for 5 or more times per week. An increment of 20 g of daily fish intake was related to a 6% lower risk of HF （RR： 0.94, 95% CI, 0.90 to 0.97; P for trend = 0.001）. Conclusions This meta-analysis suggests that there is a dose-dependent inverse relationship between fish consumption and HF incidence. Fish intake once or more times a week could reduce HF incidence.

Non-homologous functions of the AlkB homologs

TheDNArepair enzyme AlkB was identified in E.coli more than three decades ago.Since then,nine mammalian homologs,all members of the superfamily of alpha-ketoglutarate and Fe(II)-dependent dioxygenases,have been identified(designated ALKBH1–8 and FTO).While E.coli AlkB serves as a DNA repair enzyme,only two mammalian homologs have been confirmed to repair DNA in vivo.The other mammalian homologs have remarkably diverse substrate specificities and biological functions.Substrates recognized by the different AlkB homologs comprise erroneous methyl-and etheno adducts in DNA,unique wobble uridine modifications in certain tRNAs,methylated adenines in mRNA,and methylated lysines on proteins.The phenotypes of organisms lacking or overexpressing individual AlkB homologs include obesity,severe sensitivity to inflammation,infertility,growth retardation,and multiple malformations.Here we review the present knowledge of the mammalian AlkB homologs and their implications for human disease and development.

右旋美托咪啶-咪达唑仑与丙泊酚用于小儿磁共振检查中麻醉维持的比较

背景右旋美托咪啶是一种仪，受体激动剂，目前正在研究其是否适合用于小儿麻醉。本研究旨在比较右旋美托咪啶一咪达唑仑与丙泊酚对于七氟烷麻醉儿童磁共振扫描（M对）中的药效学反应差异。方法40例1～10岁，ASA1或2级，拟行MRI检查的患儿，随机分为2组，两组均用七氟烷诱导，一组以右旋美托咪啶．咪达唑仑维持麻醉，另一组以丙泊酚维持麻醉。右旋美托咪啶组先静注负荷量（1μg／kg）后持续泵入（0．5μg·kg^-1·h^-1）。开始泵注后静注咪达唑仑（0．1mg／kg）。丙泊酚持续泵入（250—300μg·kg^-1·min^-1）。由一名不了解麻醉方案的护士来记录复苏时间及血流动力学变化。结果右旋美托咪啶组手术后完全恢复及出院时间明显长于（约15分钟）丙泊酚组。与丙泊酚组比较，右旋美托咪啶组心率减慢，收缩压增高。两组呼吸系统指标相近。恢复过程中，两组血流动力学反应相近。在麻醉及手术后恢复过程中，心肺指标均在同年龄段儿童的正常范围内。无麻醉意外发生。结论在MRＩ检查中，右旋美托咪啶．咪达唑仑提供足够的麻醉深度，但-I丙泊酚相比麻醉复苏时间稍长。与丙泊酚组比较，使用右旋美托咪啶的患儿心率慢、收缩压高。两种方式的呼吸系统指标相近。

比较Episure^TM AutoDetect^TM注射器和玻璃注射器用于判断产妇硬膜外间隙的先导研究

Episure^TM AutoDetect^TM注射器是一种内置弹簧的新型注射器，由于注射器内部使用压缩弹簧对针栓保持了持续的压力，能够自动检测硬膜外穿刺过程中的阻力丧失。本项先导研究在接受硬膜外镇痛的产妇中，比较了使用Episure^TM AutoDe-tect^TM注射器和标准玻璃注射器判断穿刺进入硬膜外间隙的准确性。初级观察指标为硬膜外镇痛失败的发生率。研究共纳入325例产妇。其中291例（90％）硬膜外镇痛操作由8名住院医师实施，其余34例（10％）由2名主治医师实施。玻璃注射器组中有5例硬膜外镇痛失败，Episure^TM AutoDetect^TM注射器组无一例硬膜外镇痛失败（P=0．025）。

5-羟色胺受体拮抗剂用于剖宫产患者鞘注吗啡后瘙痒和恶心呕吐的预防与治疗：系统回顾和荟萃分析

背景5-羟色胺受体拮抗剂用于剖宫产患者鞘内吗啡镇痛后瘙痒和恶心呕吐的预防和治疗，本文对其总体疗效进行了系统回顾。方法本文对一系列有关剖宫产患者应用任何一种5-羟色胺受体拈抗剂或安慰剂以预防和治疗瘙痒、恶心、呕吐的随机对照研究进行了回顾分析。所涉及的文章均真实有效，资料均由作者独立收集并以95％可信区间的相对危险度（relativerisks，RR）概括。结果本综述包括9项随机对照研究，涉及1152例患者，其中539例接受5-羟色胺受体拮抗剂治疗，413例接受安慰剂治疗，另外200例患者因接受其他止吐药治疗而未参与分析。与安慰剂组相比，5-羟色胺受体拮抗剂组瘙痒发生率并未降低[80．7％VS85．8％，RR（95％CI）=0．94（0．81—1．09）]，然而5-羟色胺受体拮抗剂的应用降低了剧烈瘙痒发生率和瘙痒的治疗需求[需治疗数（number-needed-to—treat，NNT）分别为12和15]。5-羟色胺受体拮抗剂对于已出现的瘙痒疗效强于安慰剂，NNT差别为3。5-羟色胺受体拈抗剂组与安慰剂组相比，术后恶心[22．0％VS33．6％，RR（95％CI）=0．75（0．58。0．96）]和呕吐[7．7％VS16．8％，RR（95％CI）=0．49（0．30—0．81）]的发生率显著降低，术后需应用5．羟色胺受体拮抗剂进行补救性止吐治疗的发生率也明显降低[9％VS23％，RR（95％CI）=0．38（0．21—0．68）]。结论剖宫产的产妇鞘内给予吗啡镇痛，尽管预防性应用5一羟色胺受体拈抗剂不能降低瘙痒的发生率，但是却明显降低了剧烈瘙痒和需要治疗的瘙痒、术后恶心和呕吐的发生率以及术后补救性止吐治疗的需要。对于已发生的瘙痒治疗也同样有效。虽然需更多的研究加以证实，但目前的研究资料表明，在这类患者群体中常规预防性使用此类药物是值得推崇的。

儿童手术室外诊疗操作丙泊酚镇静／麻醉引起不良反应的性质和发生率：来自儿童镇静研究协会的报道

目的通过分析由一大批儿科专家提供的儿童接受手术室外镇静或麻醉的前瞻性数据资料，来描述丙泊酚镇静或麻醉引起不良反应的性质和发生率。方法数据搜集由儿童镇静研究协会完成，此协会是致力于提高儿童镇静、麻醉水平的国际性合作机构。前瞻性选取在临床操作时需辅助镇静或麻醉的患儿。初步准入标准为需要某种形式的镇静或麻醉来完成手术室外诊疗操作的患儿，没有排除标准。采用以网络为基础的数据收集工具，采集的资料有：人口统计学资料、原发病、并存疾病、临床操作、使用药物、操作时间和苏醒时间、药物剂量、麻醉结果、气道干预和不良反应。本研究评价所有使用丙泊酚作为主要镇静或麻醉药物的病例。结果在研究期间2004年7月1日至2007年9月1日，共有37家机构提供了49836例丙泊酚镇静或麻醉的病例。无一例死亡，其中心肺复苏2次，镇静或麻醉中误吸发生了4次。非严重事件中血氧饱和度低于90％持续超过30秒发生较多（每10000例发生154次）。中枢性窒息或气道梗阻每10000例中发生575次，喘鸣、喉痉挛、分泌物增多和呕吐发生率分别为每10000例50、96、341和49次。意外住院者为每10000例中7．1次。一项未经调整的分析显示，麻醉医师和其他医务人员相比，肺部不良反应的发生率不存在差别。结论本研究报道了儿童手术室外诊疗操作辅助丙泊酚镇静或麻醉的大量病例。搜集到的数据显示，在一些可以提供高质量镇静／麻醉服务的机构中，采用丙泊酚镇静或麻醉难免出现严重不良反应。但这一临床操作的安全性取决于整个系统处理非严重并发症的能力。因此，本研究揭示了培训和认证丙泊酚镇静或麻醉实施者的影响因素，以及提高此药物临床应用安全性所需的相关团队的特征。

麻醉科住院医师通常不能恰当使用2007美国心脏病学会／美国心脏协会（ACC／AHA）指南评估模拟患者

背景2007美国心脏病学会／美国心脏协会（American College of Cardiology/American Heart Association, ACC/AHA）有关围术期心脏评估与非心脏手术医疗保障的指南是围术期心脏评估的公认标准。麻醉培训计划要求教授这些评估方法。我们评估了美国全国范围内麻醉科住院医师在评估临床常见场景下模拟患者时能够正确使用ACC／AHA指南所建议的测试评估方法的百分比人数。方法24所培训机构中的麻醉科住院医师志愿者参加，设置以外科手术、患者危险因素和患者功能能力为特征的6种场景。均随机分配所有场景和针对每种场景的5种推荐建议。分配之前，美国24所不同培训机构的高级麻醉医师与2007年ACC／AHA指南的第一作者一同确认该网络调查的推荐建议恰当。结果参加的548名住院医师占美国麻醉科培训医师的12％，包括48名PGY-1S（麻醉专科培训前第一年）、166名临床麻醉工作一年的住院医师（CA-1）、161名CA-2s和173名CA-3s。评估活动性心脏病的患者时，建议的评估与指南一致的住院医师为78％（95％可信上限）。然后，在剩余的5种场景中，给出恰当建议的住院医师为46％（95％可信上限）。结论结果显示，美国全国范围内不足一半的麻醉科住院医师能够正确地应用术前心脏评估标准的方法。必须进一步研究来阐明正确的干预措施，如决策支持工具的应用、增加常规使用指南的清晰度、调整教育计划和（或）负责教员更熟悉该教材。